Effect Effect of endoscopic pyloric therapies for patients with nausea and vomiting and functional obstructive gastroparesis

Gastroparesis (GP) is associated with loss of interstitial cells of Cajal (ICCs) and gastric dysrhythmias such as tachygastria. We hypothesized that a subset of patients with GP, normal 3 cycles per minute (cpm) gastric myo-electrical activity (GMA), and normal upper endoscopy may respond to pyloric therapies. Aims: To determine the effect of botulinum toxin A (btA) injection or balloon dilation (BD) of the pylorus on symptoms and body weight in patients with GP and 3 cpm GMA. Methods: Patients were identified who had GP, normal 3 cpm GMA, and normal endoscopy that excluded mechanical obstruction of the pylorus. Electrogastrograms (EGG) with water load tests (WLT) were recorded to determine GMA. Gastric emptying was measured with 4 h scintigraphy. Each patient underwent up to three pyloric treatments with btA or BD. Results: Thirty-three patients (29 women) with an average age of 42 years were studied. Seventy-nine percent had idiopathic GP and 21% had diabetic GP. The average percent meal retained at 4 h was 42% and each EGG test showed normal 3 cpm GMA. Nausea was the major symptom in 76% of patients. Complete or partial symptom response occurred in 75%, 72%, and 88% of patients after the first, second, or third endoscopic pyloric treatment, respectively. Overall, 78% of the 33 patients reported improvement in symptoms and average weight gain was 1.54 lb from baseline to final treatment (p < 0.04). Conclusion: Pyloric therapies appear to be effective treatments in symptomatic patients with GP and 3 cpm GMA and controlled trials are warranted. (C) 2016 Elsevier B.V. All rights reserved.